Antegrade jj stenting after percutaneous renal procedures: The ‘pull and push’ technique

Abstract

A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL.

Preventing intra-urethral migration of a guidewire during antegrade placement of a JJ stent: a technical modification

“…In the ‘pull and push’ technique,4 the ureteric catheter is gradually withdrawn antegradely until its lower end lies just above the pubic symphysis. A guidewire is then passed antegradely through the ureteric catheter until its floppy end gets coiled in the bladder.…”

“…Although stent insertion can be performed by using either an antegrade or a retrograde approach, the antegrade approach is preferred due to ease of insertion with minimal urethral manipulation. The various techniques of antegrade JJ stenting after PCNL described in the literature include a ‘reverse-zebra’ technique,2 passing the JJ stent over a ‘through-and-through’ guidewire technique3 and a ‘pull and push’ technique 4. However, intra-urethral migration of the guidewire during antegrade JJ stent placement with these procedures is quite common and leads to an increase in operative time and radiation exposure when placing its distal end back into the bladder.…”

Antegrade JJ stenting after percutaneous renal procedures: The ‘pull and push’ technique

“…We read with keen interest an interesting point of technique by Ratkal and Sharma [1] about a ‘pull and push’ technique of antegrade JJ stent placement after percutaneous renal procedures. The authors need to be complimented for a very interesting technique.…”